HBA-CCH H.B. 1202 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1202 By: Brimer Business & Industry 2/28/2001 Introduced BACKGROUND AND PURPOSE Under current law, the Texas Workers' Compensation Commission (TWCC) requires an employee who sustains a compensable injury to receive medical treatment from a doctor chosen from a list of doctors approved by TWCC. Currently, each doctor licensed in this state on January 1, 1993, is on the list, unless subsequently deleted for any conduct TWCC considers relevant. House Bill 1202 establishes criteria for doctors to be eligible to be on the list of approved doctors and requires TWCC to employ a medical advisor to appoint a medical review panel to assist in recommending sanctions for doctors on the list. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Workers' Compensation Commission in SECTION 1 (Sections 408.023 and 408.0235, Labor Code) and in SECTION 4 of this bill. ANALYSIS House Bill 1202 amends the Labor Code relating to the medical review of health care provided under the workers' compensation insurance system. The bill provides that each doctor licensed in this state is eligible to be on the Texas Worker's Compensation Commission's (TWCC) list of approved doctors if the doctor registers with TWCC in the manner presented by commission rules and complies with the requirements adopted by TWCC. The bill requires TWCC to develop a list of doctors who are approved to provide workers' compensation services and sets forth provisions authorizing out-of-state doctors to perform these services. TWCC is required, by rule, to establish reasonable requirements for doctors who provide services as treating or designated doctors, perform medical peer review, or perform utilization review of medical benefits. The bill requires TWCC to issue to an approved doctor a renewable certificate of registration that is valid for four years. Each doctor, including a doctor who performs required medical examinations, must hold a certificate of registration and be on the list of approved doctors to perform workers' compensation services or to receive payment for those services (Sec. 408.023). TWCC by rule is required to establish criteria for removing a doctor from the list of approved doctors, for imposing sanctions for violations, and for authorizing reduced utilization review controls. The bill modifies the criteria for removing a doctor from the list. The bill also requires TWCC, by rule, to establish procedures under which a doctor may apply for reinstatement to the list of approved doctors, or for restoration of doctor practice privileges removed by TWCC based on sanctions. The bill specifies conditions for which the executive director of TWCC is authorized to impose sanctions on a health care provider, an insurance carrier, or a utilization review agent (Sec. 408.0235). TWCC is authorized to contract with a health care provider to develop, maintain, or review medical policies or fee guidelines or to review compliance with these policies or fee guidelines. The bill authorizes TWCC to contract with a health care provider professional review organization or other entity for medical consulting services. The bill requires TWCC to establish standards for these contracts (Sec. 413.051). The bill requires TWCC to employ or contract with a doctor who serves as a medical advisor (advisor) and specifies the advisor's duties (Sec. 413.0511). The bill authorizes the advisor to establish an independent medical quality review panel of health care providers as an advisory body to assist the advisor in providing recommendations for sanctions on health care providers and utilization review agents and for modifications to the list of approved doctors. The bill requires the Texas State Board of Medical Examiners and the Texas State Board of Podiatric Medical Examiners to develop lists of physicians and chiropractors licensed by those agencies who have demonstrated experience in workers' compensation or utilization review from which the advisor shall appoint the members of the medical quality review panel. Except for harm resulting from gross negligence, malice, or recklessness, a person on the medical quality review panel is not liable for an act or omission committed in the course and scope of the person's service as a member of the panel. The actions of a person serving on the medical quality review panel do not constitute utilization review (Sec. 413.0512). The bill prohibits information that is confidential under current law from being disclosed except in a criminal proceeding, in a hearing conducted by or on behalf of TWCC, in a hearing conducted by another licensing or regulatory authority, or on a finding of good cause in an administrative or judicial proceeding involving a disciplinary action or the enforcement of the provisions of this bill (Sec. 413.0513). The bill requires TWCC to adopt rules as required by this Act no later than December 1, 2001. A person is not required to hold a certificate of registration to perform medical services before March 1, 2002 (SECTION 4). EFFECTIVE DATE September 1, 2001.